Paralyzing injuries and illnesses such as cervical spinal cord injury, brainstem stroke, neuromuscular failure (e.g., myasthenia gravis, Guillain-Barre Syndrome), or multi-trauma can leave patients awake and hospitalized, yet unable to communicate adequately for days, weeks, or longer. While some patients may use eye blinks or other simple means to communicate 'yes'or 'no', this slow and laborious method often results in frustration and inadequate communication during a period when the ability to answer and ask questions regarding one's medical care is most critical. Based upon encouraging preliminary data from use of brain-computer interfaces (BCIs) in the controlled home environment of people with ALS, this proposed translational research will explore whether a similar technology can be developed for patients just admitted to the intensive care unit or acute hospital setting. A P300-BCI that requires only an EEG electrode cap, amplifier, and a laptop/patient monitor will be provided to 24 hospitalized patients who are unable to speak. Using the P300-BCI, patients will try to "type" letters of the alphabet simply by attending to desired letters as they appear on the monitor. Our first aim is to determine the classifier algorithm that recognizes EEG signatures (the "P300 wave") associated with attention to instructed letters ("copy-spelling"). This will require studying the efficiency of the initial "copy-spelling" task, as well as offline EEG analyses to optimize copy-spelling performance. Our second aim is to determine whether patients in acute care settings can use the P300-BCI to communicate, and to optimize further the user interface to provide rapid, accurate communication between the acutely paralyzed patient and his/her healthcare staff and family. Patients able to use the P300-BCI to communicate will be provided with a BCI system for use during their hospitalization. Toward the NIDCD's mission of treating communication disorders and improving delivery of services to people with communication disorders, this multi-institutional, multi-disciplinary, translational study will support the collaboration between two premier research groups: the basic science and BCI development team at the Wadsworth Center in Albany, NY, and the clinical research and neurocritical care teams in the Departments of Neurology at Massachusetts General Hospital and Brigham and Women's Hospital at Harvard Medical School, Boston, MA. Paralyzed patients in the hospital are sometimes unable to talk or communicate, despite being fully awake. This research aims to test and develop a "brain-computer interface" system that could restore the ability to type words, just by looking at letters as they flash on a computer screen.